Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 2015; 34(03): 220-224
DOI: 10.1055/s-0035-1559892
Case Report | Relato de Caso
Thieme Publicações Ltda Rio de Janeiro, Brazil

Lipomatose epidural idiopática familiar: relato de três casos e revisão da literatura

Familiar Idiopathic Spinal Epidural Lipomatosis: Report of Three Cases and Review of the Literature
Cléciton Braga Tavares
1   Médico Neurocirurgião e Professor de Neurologia/Neurocirurgia da Faculdade de Ciências Médicas, Universidade Estadual do Piauí, Teresina, PI, Brasil
,
Emerson Brandão Sousa
1   Médico Neurocirurgião e Professor de Neurologia/Neurocirurgia da Faculdade de Ciências Médicas, Universidade Estadual do Piauí, Teresina, PI, Brasil
,
Igor Brenno Campbell Borges
2   Médico Neurocirurgião da Unidade de Neurocirurgia do Hospital de Base do Distrito Federal (HBDF), Brasília, DF, Brasil
,
Alessandro F. Cardoso
2   Médico Neurocirurgião da Unidade de Neurocirurgia do Hospital de Base do Distrito Federal (HBDF), Brasília, DF, Brasil
,
Rodrigo Carvalho Diniz
3   Médico Neurocirurgião e Preceptor do Programa de Residência Médica em Neurocirurgia do HBDF, Brasília, DF, Brasil
,
Francisca das Chagas Sheyla Almeida Gomes Braga
4   Enfermeira do Hospital Universitário do Piauí, Universidade Federal do Piauí (UFPI), Teresina, PI, Brasil
› Author Affiliations
Further Information

Publication History

01 May 2015

12 June 2015

Publication Date:
11 August 2015 (online)

Resumo

Lipomatose epidural é a doença causada pelo aumento da quantidade de gordura no espaço epidural da coluna vertebral, levando à compressão medular ou radicular. A medula toracolombar é a mais comumente envolvida. É geralmente encontrada em homens. As principais causas são a obesidade, altos níveis de corticoides exógenos ou endógenos e hipotireoidismo. A forma idiopática é rara, correspondendo a 17% dos casos. Manifesta-se como mielopatia compressiva ou das raízes da cauda equina. A ressonância magnética é o exame de escolha; sugere-se o diagnóstico quando a espessura da camada de gordura epidural ultrapassa 6 mm. Nós adotamos neste caso a laminectomia com ressecção da gordura epidural, citada como uma das possíveis formas de tratamento. A maioria dos trabalhos demonstra melhora gradual, acentuada ou completa, do déficit neurológico nos primeiros 2 anos após a cirurgia.

Abstract

Epidural lipomatosis is a disease caused by increased fat content in the epidural space of the spine, leading to root or spinal cord compression. The thoracolumbar spinal cord is the most commonly involved. It is usually found in men. The main causes are obesity, high levels of exogenous or endogenous steroids and hypothyroidism. The idiopathic form is rare, accounting for 17% of cases. It manifests as compressive myelopathy or radiculopathy. MRI is the test of choice, suggests the diagnosis when the thickness of the epidural fat exceeds 6mm. We adopt in this case laminectomy with fat resection, cited as one of the possible forms of treatment. Most studies show a gradual improvement, marked or complete neurological recovery in the first two years after surgery.

 
  • Referências

  • 1 Robertson SC, Traynelis VC, Follett KA, Menezes AH. Idiopathic spinal epidural lipomatosis. Neurosurgery 1997; 41 (1) 68-74 , discussion 74–75
  • 2 Koch CA, Doppman JL, Watson JC, Patronas NJ, Nieman LK. Spinal epidural lipomatosis in a patient with the ectopic corticotropin syndrome. N Engl J Med 1999; 341 (18) 1399-1400
  • 3 Lévy-Weil FE, Feldmann JL. Lipomatose épidurale. Presse Med 2000; 29 (9) 469-475
  • 4 Fassett DR, Schmidt MH. Spinal epidural lipomatosis: a review of its causes and recommendations for treatment. Neurosurg Focus 2004; 16 (4) E11
  • 5 Dihlmann SW, Mayer HM. [Lumbar epidural lipomatosis]. Z Rheumatol 1995; 54 (6) 417-423
  • 6 López-González A, Resurrección Giner M. Idiopathic spinal epidural lipomatosis: urgent decompression in an atypical case. Eur Spine J 2008; 17 (Suppl. 02) S225-S227
  • 7 Dumont-Fischer D, Rat AC, Saidenberg-Kermanac'h N, Laurent S, Cohen R, Boissier MC. Spinal epidural lipomatosis revealing endogenous Cushing's syndrome. Joint Bone Spine 2002; 69 (2) 222-225
  • 8 Akhaddar A, Ennouali H, Gazzaz M, Naama O, Elmostarchid B, Boucetta M. Idiopathic spinal epidural lipomatosis without obesity: a case with relapsing and remitting course. Spinal Cord 2008; 46 (3) 243-244
  • 9 Lee SB, Park HK, Chang JC, Jin SY. Idiopathic thoracic epidural lipomatosis with chest pain. J Korean Neurosurg Soc 2011; 50 (2) 130-133
  • 10 Borré DG. Epidural lipomatosis. J Neurosurg Spine 2007; 7 (4) 463-464
  • 11 Oikonomou A, Birbilis T, Gymnopoulou E, Prassopoulos P. Paget disease of the spine manifested by thoracic and lumbar epidural lipomatosis: magnetic resonance imaging findings. Spine 2007; 32 (25) E789-E792
  • 12 Kuhn MJ, Youssef HT, Swan TL, Swenson LC. Lumbar epidural lipomatosis: the “Y” sign of thecal sac compression. Comput Med Imaging Graph 1994; 18 (5) 367-372
  • 13 Badami JP, Hinck VC. Symptomatic deposition of epidural fat in a morbidly obese woman. AJNR Am J Neuroradiol 1982; 3 (6) 664-665
  • 14 Haddad SF, Hitchon PW, Godersky JC. Idiopathic and glucocorticoid-induced spinal epidural lipomatosis. J Neurosurg 1991; 74 (1) 38-42
  • 15 Sairyo K, Sakai T, Higashino K, Hirao B, Katoh S, Yasui N. Minimally invasive excision of lumbar epidural lipomatosis using a spinal endoscope. Minim Invasive Neurosurg 2008; 51 (1) 43-46
  • 16 Frank E. Endoscopic suction decompression of idiopathic epidural lipomatosis. Surg Neurol 1998; 50 (4) 333-335 , discussion 335
  • 17 Payer M, Van Schaeybroeck P, Reverdin A, May D. Idiopathic symptomatic epidural lipomatosis of the lumbar spine. Acta Neurochir (Wien) 2003; 145 (4) 315-320 , discussion 321
  • 18 Lisai P, Doria C, Crissantu L, Meloni GB, Conti M, Achene A. Cauda equina syndrome secondary to idiopathic spinal epidural lipomatosis. Spine 2001; 26 (3) 307-309
  • 19 Min WK, Oh CW, Jeon IH, Kim SY, Park BC. Decompression of idiopathic symptomatic epidural lipomatosis of the lumbar spine. Joint Bone Spine 2007; 74 (5) 488-490